The Changing Future of Drug Formularies

At the Drug Information Association annual meeting held in Montreal, Peter Penna, Pharm. D., vice president of managed pharmacy for Cigna Healthcare, spoke of the future of drug formularies, predicting that they would move "to a list of drugs that really are going to promote best outcomes." In an interview with Psychiatric Times, Penna elaborated on the future of drug formularies and how he sees them changing.
Formularies in managed care evolved out of formularies in hospitals and have been around since drugs became relatively commonly used in patient settings, Penna explained. "Today, formularies are widely used by hospitals, managed care organizations, pharmacy benefit management companies, home health agencies and nursing home services."

Typical Drug Formularies

According to Penna, typically there are around 1,500 chemical entities on a drug formulary, but he believes managed care companies will begin to focus just on 50 or 100 items and ignore everything else.

"I said this at the meeting, and it was largely misconstrued," said Penna. "When we have to make a decision on how a drug should or should not be used we usually don't have the best information possible to make it." Penna noted that either the drug has not been in use long enough to get a true look at its side effects, or the drug companies have the information but they don't want to release it because it won't look particularly good. He cites the recent recall of Redux and Pondimin as a good example.

Penna continued, "I think that in a couple of years, once we are able to hook together data bases about patients-such that you can tie together patients' drug exposure, physician office visits, hospitalization data, physical therapy, utilization, everything that happens to a patient-then you can tie all of it together into something from which you can extract information. We can go in and say, 'OK computer, identify a population of patients with this disease who are treated with treatment A, compare that with a similar population of patients with a similar disease who are exposed to treatment B, and tell us who had the better outcomes.' When it happens, I think we'll be able to much more easily go and determine which drugs work best in which patients."

When asked whether practice guidelines recommending specific drugs as first-line treatment are taken into consideration when evaluating drugs, Penna said committees do look at them, and if a drug is prominent in a nationally recognized protocol, e.g., the Agency for Health Care Policy and Research (AHCPR), then it will carry a lot of weight. The pharmacy and therapeutic (P and T) committees, which make decisions on drug inclusions, try to get as much information as possible in order to make the best decisions.